Association
of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943Omnia pro aegroto

Lott takes on 'monopoly' of outpatient codes

By Dave Boyer
THE WASHINGTON TIMES

Senate Minority Leader Trent Lott is seeking to end the American Medical
Association's federally approved "monopoly" of the codes that doctors use to
define Medicare and Medicaid outpatient services.

In a letter to Health and Human Services Secretary Tommy G. Thompson,
Mr. Lott said the system is unfair to patients and contributes to rising
health care costs. The AMA receives a reported $71 million in annual
royalties and book sales by controlling the codes, he said.

By aggressively guarding its copyright in court, Mr. Lott said, "the AMA
has also been able to control who uses the codes and who knows what about the
cost of doctor services."

The complex issue arises just as the Senate Finance Committee, of which
Mr. Lott is a member, prepares to take up reforming the Medicare system and
adding prescription drug benefits to the program. It also comes as a
House-Senate conference committee addresses a patients' rights bill that
President Bush said must include restrictions on lawsuits.

"The intellectual property rights in a federally mandated billing system
for Medicare and Medicaid has a major impact on public policy," said Lott
spokesman Ronald Bonjean. "Senator Lott believes that Americans should not
have to pay more for their health care because the AMA owns the nation's
outpatient billing system."

The federal government sets the costs that doctors can charge Medicare
and Medicaid for various medical procedures.

But by owning the codes that define each procedure and controlling who
has access to that information, Mr. Lott argues, the AMA is keeping the
public in the dark about "comparison shopping" for doctors and forcing
private insurers to adopt the AMA's billing standards as well.

A spokesman for the AMA would not comment on the issue yesterday, but
the organization has said patients should not choose doctors based on billing
comparisons.

The Medicare billing system has been in place since 1983, when the
federal government granted the AMA exclusive use and copyright of the
"current procedural terminology" (CPT) code system for the purpose of
reimbursing Medicare and Medicaid bills from doctors for outpatient services.

But Mr. Lott told Mr. Thompson in the letter that the system had
hampered efforts to reduce fraud in billing the government and in allowing
patients to shop for reasonably priced health care.

"The AMA has been able to impose on the entire nation the AMA's
obviously self-interested policy against consumers comparison shopping for
medical care based on price by suing Web sites and others to prohibit them
from posting comparisons of doctor and other medical fees on the Internet
using the CPT code," Mr. Lott said. "Comparison shopping and proper billing
to avoid mistakes and fraud are two of the most potent weapons we have to
combat the routine double-digit increases in health care costs that keep
millions of Americans uninsured."

The government's Centers for Medicare and Medicaid Services controls the
codes used by hospitals and other providers to bill Medicare and Medicaid for
inpatient services. That information is available to the public.

Mr. Lott is asking HHS to:

Develop a universal coding system "for all of the federal government's
health information needs."

Determine how much the government and private insurers could save from
a universal code system.

Find out how much the AMA has received in royalties, book sales and
other revenue from its copyright of the CPT code since 1983.